| NPI | 1164533386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101022994) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 200301017) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101022994) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-02-11 |