| NPI | 1932115821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 31690) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 31690) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2018-07-17 |