| NPI | 1447429097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 4311) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 4311) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 4311) | |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2023-12-08 |