| NPI | 1891976908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D0020522) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 64075) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA a95934) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2011-09-07 |