| NPI | 1255523296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2022035062) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 54438) |
| 207N00000X Dermatology (Licence: IL 036.129240) | |
| 207N00000X Dermatology (Licence: LA 333863) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036.129240) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2023-10-11 |