| NPI | 1538252911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: HI MD-10449) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: HI MD10449) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2026-01-13 |