| NPI | 1710195003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 73100) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A116875) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-02-12 |