| NPI | 1912392390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 62235) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 62235) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-02-03 |