| NPI | 1609855402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 5101015191) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5101015191) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-07-30 |