| NPI | 1962849463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 56778) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A147575) |
| 207N00000X Dermatology (Licence: KY 51181) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 51181) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A14575) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-12-29 |