| NPI | 1184073801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A168460) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 75308-20) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2023-04-14 |