| NPI | 1760459069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN MD35071) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TN MD35071) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TN MD35071) | |
| Enumeration Date | 2006-03-06 |
| Last Update Date | 2007-07-08 |