| NPI | 1881821585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IN 01083501A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME 129457) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2022-08-17 |