| NPI | 1790981207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA 38816) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 38816) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2015-07-30 |