| NPI | 1497810493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME138846) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME138846) |
| 207ND0900X Dermatology, Dermatopathology (Licence: NC 33875) | |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2025-08-27 |