| NPI | 1205362043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 98511) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT 98511) |
| 208D00000X General Practice (Licence: MT 98511) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-02-08 |