| NPI | 1861650947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX M8356) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX M8356) |
| 207N00000X Dermatology (Licence: TX M8356) | |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2020-10-19 |