| NPI | 1598925513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 63602) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2013018998) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2013018998) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2018-07-23 |