| NPI | 1063040145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MO 2024033479) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2024033479) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2025-08-26 |