| NPI | 1326333253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME170398) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME170398) |
| 207N00000X Dermatology (Licence: IL 036.147801) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2026-08-05 |