| NPI | 1730254327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2007021723) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 12339) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 12339) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2008-09-25 |