| NPI | 1508069303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2015-01191) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2015-01191) |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2024-07-08 |