| NPI | 1457823809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME143350) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME143350) |
| 207N00000X Dermatology (Licence: IL 036.148375) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME143350) | |
| Enumeration Date | 2018-12-26 |
| Last Update Date | 2022-08-03 |