| NPI | 1568538783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME98259) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME98259) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 229964) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-09-12 |