| NPI | 1669403861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-23188) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 04-23188) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2016-04-03 |