| NPI | 1558347526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 47861) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 37751) |
| 207N00000X Dermatology (Licence: MN 47861) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2020-10-05 |