| NPI | 1750462198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 20286) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 40742) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 40742) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-12-21 |