| NPI | 1982994455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35-126612) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD457066) |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2021-01-19 |