| NPI | 1164700738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD192149) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD192149) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2026-07-22 |