| NPI | 1639103138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A103070) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A103070) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-01-02 |