| NPI | 1477664480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 58289) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MA 58289) |
| 207N00000X Dermatology (Licence: FL ME176828) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2025-10-14 |