| NPI | 1922158500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 3466) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 73663) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ND 10791) | |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2019-02-12 |