| NPI | 1659344513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A9328) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 20A9328) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-10-07 |