| NPI | 1730390055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD60320800) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA 207ND0101X) |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2014-03-05 |