| NPI | 1780832725 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 20664) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT 20664) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2020-07-06 |