| NPI | 1194162230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD195653) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC MMD89666MD) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC MMD89666MD) | |
| 207N00000X Dermatology (Licence: NC 2023-00924) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2023-00924) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2026-07-21 |