| NPI | 1083024921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 7027) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 007027) |
| 207N00000X Dermatology (Licence: AZ 7027) | |
| 208D00000X General Practice (Licence: FL OS13524) | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-02-20 |