| NPI | 1164953378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 90275) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101272812) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2025-01-22 |