| NPI | 1902828049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME98276) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2006012910) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME98276) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-10-06 |