| NPI | 1376610048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M4341) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: ID M4341) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: ID M4341) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2022-08-26 |