| NPI | 1588044366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WI 73195) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 73195) |
| 207N00000X Dermatology (Licence: MN 60799) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2020-10-05 |