| NPI | 1255697090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 304266) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 24733) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA 304266) | |
| Enumeration Date | 2012-04-05 |
| Last Update Date | 2021-05-18 |