| NPI | 1750458535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS14079) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: FL OS14079) |
| 207ND0900X Dermatology, Dermatopathology (Licence: KS 530782) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MO 2004011010) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2019-08-12 |