| NPI | 1780863779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 61364-20) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 61364-20) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2018-11-05 |