| NPI | 1578785002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 200700015) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2007-00015) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2011-12-05 |