| NPI | 1821038746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 45931) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A90894) |
| 207N00000X Dermatology (Licence: MN 45931) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-02-23 |