| NPI | 1326239120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 36694) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 36694) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2026-03-09 |