| NPI | 1285630061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2001005039) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2001005039) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2001005039) | |
| Enumeration Date | 2005-06-25 |
| Last Update Date | 2022-03-04 |