| NPI | 1720220890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0057198) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CO DR.0057198) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2017-03-22 |