| NPI | 1720014954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NH 14745) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NH 14745) |
| 207N00000X Dermatology (Licence: NH 14745) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2015-01-22 |