| NPI | 1801835996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A87333) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 206031) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2017-06-07 |