| NPI | 1578569463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI AC036627) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI AC036627.) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MI AC036627) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2023-04-21 |