| NPI | 1598782476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME125681) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 63118) |
| 207N00000X Dermatology (Licence: NC 2020-00017) | |
| 207N00000X Dermatology (Licence: FL ME125681) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2020-00017) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2023-01-19 |