| NPI | 1700848355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA md00049097) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA md00049097) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2020-05-01 |