| NPI | 1598111999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS20484) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0063699) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS20484) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR.0063699) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2023-10-17 |