| NPI | 1902850126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35.067219) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.067219) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME133595) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2023-07-11 |