| NPI | 1922234780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 56445) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MN 56445) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2018-10-31 |