| NPI | 1043214505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO R9730) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MO R9730) |
| 207N00000X Dermatology (Licence: MO R9730) | |
| Enumeration Date | 2005-06-11 |
| Last Update Date | 2026-03-10 |