| NPI | 1609847821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD0046124) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD0046124) |
| 207N00000X Dermatology (Licence: AZ 12532) | |
| 207N00000X Dermatology (Licence: CA 45899) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 12532) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 45899) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-09-29 |