| NPI | 1205123296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 082110) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: GA 082110) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2023-08-10 |