| NPI | 1649538745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 40761) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 40761) |
| 207N00000X Dermatology (Licence: NC 2016-00536) | |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2020-10-05 |