| NPI | 1639163298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 36184) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME78110) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME78110) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 36184) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2021-02-15 |