| NPI | 1265795660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID O-0934) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR DO163719) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID O0934) | |
| 208D00000X General Practice (Licence: ID O0934) | |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2020-10-01 |