| NPI | 1376852087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2019020171) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2019020171) |
| 207R00000X Internal Medicine (Licence: MO 2019020171) | |
| Enumeration Date | 2010-09-29 |
| Last Update Date | 2025-04-17 |