| NPI | 1841556396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME134777) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.131552) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.131552) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME134777) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2020-02-10 |