| NPI | 1821299751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: UT 54578581204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 4153) |
| 207N00000X Dermatology (Licence: UT 5457858-1204) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2021-12-06 |