| NPI | 1659702942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A155759) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A155759) |
| 207N00000X Dermatology (Licence: MN 107728) | |
| 207ND0900X Dermatology Dermatopathology (Licence: CA A155759) | |
| 207ND0900X Dermatology Dermatopathology (Licence: MN 58373) | |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2020-12-29 |