| NPI | 1306250790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 59157) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA10367100) |
| 207N00000X Dermatology (Licence: FL ME140828) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA10367100) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME140828) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME140828) | |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2024-03-22 |