| NPI | 1437447745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 66757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R76653) |
| 183500000X Pharmacist (Licence: AZ S019814) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 66757) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2026-03-08 |