| NPI | 1407884315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A9405) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A9405) |
| 207P00000X Emergency Medicine (Licence: CA 20A9405) | |
| 207R00000X Internal Medicine (Licence: CA 20A9405) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2026-07-06 |