| NPI | 1366804569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5315075625) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MI 5315075625) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: MI 5315075625) | |
| 207ZP0101X Pathology Anatomic Pathology (Licence: MI 5315075625) | |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: MI 5315075625) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2024-07-23 |