| NPI | 1720075401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME85844) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME85844) |
| 207ND0900X Dermatology Dermatopathology (Licence: FL ME85844) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2009-03-13 |