| NPI | 1902080559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 41690) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 41690) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2021-07-21 |