| NPI | 1093193161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A170186) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 62550) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CT 62550) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CT 62550) | |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2024-02-16 |