| NPI | 1295775732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 49076) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 49076) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2024-07-29 |