| NPI | 1881127587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A172509) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 009124) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2022-02-05 |