| NPI | 1700087806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.094116) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.094116) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2023-09-20 |