| NPI | 1841758810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR DO198449) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA OP61137574) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OR DO198449) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WA OP61137574) | |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2024-10-01 |