| NPI | 1558504803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 27070) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 27070) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2022-10-20 |