| NPI | 1124554589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 023705) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301504930) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2024-12-10 |