| NPI | 1215374186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 55959) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 55959) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2021-05-17 |