| NPI | 1912059007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A16423) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NV DO2650) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2023-03-15 |