| NPI | 1639197049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OH 35072837F) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: OH 35072837F) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2016-08-03 |