| NPI | 1609860337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101235935) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101235935) |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2010-03-10 |