| NPI | 1548766264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A19942) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A19942) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA 20A19942) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-10-19 |