| NPI | 1578895744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA DO-55426) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA DO-55426) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2026-07-28 |