| NPI | 1891768487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 12850) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC 12850) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2023-03-07 |