| NPI | 1710325758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID O1145) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR DO168846) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID O1145) | |
| 208D00000X General Practice (Licence: OR PG163364) | |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-10-01 |