| NPI | 1902893001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD070376L) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD070376L) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD070376L) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-03-27 |