| NPI | 1972765493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA MD.206061) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL md31526) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2013-11-12 |