| NPI | 1457469371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A81640) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A81640) |
| 174400000X Specialist (Licence: CA A81640) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2025-12-03 |