| NPI | 1376001479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2022-02190) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2022-02190) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2024-08-07 |