| NPI | 1548909534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AK 253319) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AK 253319) |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2026-08-27 |