| NPI | 1336567635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NM MD2018-0092) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NM MD2018-0092) |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2023-07-13 |