| NPI | 1790769438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: AL 00007430) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 00007430) |
| 207N00000X Dermatology (Licence: AL 00007430) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2021-02-23 |