| NPI | 1730101023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 5901) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 65027) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-01-20 |