| NPI | 1760427165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME124442) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL MD33308) |
| 363A00000X Physician Assistant (Licence: FL PA9102034) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-04-19 |