| NPI | 1659402196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS9788) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 075969) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 02910) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2024-03-28 |