| NPI | 1598992737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WA MD60458784) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD60458784) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2022-06-23 |