| NPI | 1912128307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 39921) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 39921) |
| 207N00000X Dermatology (Licence: MO 2007011366) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2021-07-21 |