| NPI | 1063564011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 29366) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 29366) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 29366) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: KY 29366) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2023-03-07 |