| NPI | 1518012582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME56060) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME056060) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME56060) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2020-11-03 |