| NPI | 1801097019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MS 21178) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 4312) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 4312) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2015-04-15 |