| NPI | 1861583486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID O-0508) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MO 2006018423) |
| 207N00000X Dermatology (Licence: ID O-0508) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2020-09-29 |