| NPI | 1912130287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D73150) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A90335) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A90335) | |
| 207N00000X Dermatology (Licence: MD D73150) | |
| 207N00000X Dermatology (Licence: DC MD33040) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: DC MD33040) | |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2012-01-05 |