| NPI | 1235792912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-51339) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IA MD-51339) |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: IA MD-51339) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: IA MD-51339) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2024-07-25 |