| NPI | 1881649523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 28377) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2008006946) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-10-23 |