| NPI | 1265695589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 13825) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX P5609) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 13825) | |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2025-11-25 |