| NPI | 1730364167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO 47200) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO 47200) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 47200) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2020-10-09 |