| NPI | 1932460441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101261999) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 128667) |
| Enumeration Date | 2012-05-31 |
| Last Update Date | 2020-03-15 |