| NPI | 1558708701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 3897) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 11133432-1204) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 3897) | |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2020-01-22 |