| NPI | 1548250509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301076576) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301076576) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2026-08-28 |