| NPI | 1811302359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 274656) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301106908) |
| 207N00000X Dermatology (Licence: MA 274656) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2023-12-15 |