| NPI | 1093961971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2023-00795) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2023-00795) |
| 207N00000X Dermatology (Licence: AL 42342) | |
| 207R00000X Internal Medicine (Licence: MN 51900) | |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2026-05-07 |