| NPI | 1669815452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 04-45250) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2021042022) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 58926) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2022-10-17 |