| NPI | 1104856061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0039315) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: CO 39315) |
| 207ND0900X Dermatology, Dermatopathology (Licence: CO 39315) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR.0039315) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2026-08-06 |