| NPI | 1396242244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 202400764) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL MD.44360) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 202400764) | |
| Enumeration Date | 2018-04-08 |
| Last Update Date | 2025-03-19 |