| NPI | 1619144433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WV 2596) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2007-00740) |
| 207N00000X Dermatology (Licence: FL OS 11120) | |
| 207N00000X Dermatology (Licence: WV 2596) | |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2014-10-20 |