| NPI | 1902244817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101256751) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2020-03858) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2024-05-28 |