| NPI | 1053843169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 42338) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ 56583) |
| 207N00000X Dermatology (Licence: AL 42338) | |
| 207R00000X Internal Medicine (Licence: AZ R76285) | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-12-11 |