| NPI | 1306029590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OR MD200109) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD200109) |
| 207N00000X Dermatology (Licence: OR MD200109) | |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2026-02-04 |