| NPI | 1700839057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL me0073868) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME73868) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-05-20 |