| NPI | 1083841225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 48691) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 32259) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 48691) | |
| 207R00000X Internal Medicine (Licence: AZ R71509) | |
| 207N00000X Dermatology (Licence: MO 2010010429) | |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2026-08-21 |