| NPI | 1609891472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 29473) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA G046901) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 46901) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2023-03-07 |