| NPI | 1851515381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 006021) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2007030797) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OH 34.009917) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-07-26 |