| NPI | 1588018170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID M-17515) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL MD.36224) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-02-15 |