| NPI | 1962441212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102202352) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 012202352) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2020-11-05 |