| NPI | 1871593996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: KY 34192) |
| Additional Taxonomies | 207ND0900X Dermatology Dermatopathology (Licence: KY 34192) |
| 207Y00000X Otolaryngology (Licence: KY 34192) | |
| 208200000X Plastic Surgery (Licence: KY 34192) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2022-12-15 |