| NPI | 1417030669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 9900194) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NC 99-00194) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 99-00194) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2026-08-27 |