| NPI | 1184080210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID O-1094) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: ID O-1094) |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2023-10-31 |