| NPI | 1922443464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A165830) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: CA A165830) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-01-13 |