| NPI | 1801892260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00020973) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD00020973) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-10-17 |