| NPI | 1659562650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A103862) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A103862) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2023-01-19 |