Registry details
Type
Individual
Primary specialty
Dermatology, MOHS-Micrographic Surgery
Enumerated
Apr 28, 2009
License(s)
4301106561 (MI), MD17679 (HI), MD17679 (HI), ME142263 (FL), 4301106561 (MI), 49483 (AZ), A125540 (CA), 2019-01570 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 118 GATEWAY BLVD STE A | Mooresville, NC 28117-6542 | 704-230-1302 |
| MAILING | 118 GATEWAY BLVD STE A | Mooresville, NC 28117-6542 | 704-230-1302 |
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