| NPI | 1972607158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2007005538) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2003014484) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2007005538) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2023-07-05 |