| NPI | 1619901634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OK 17721) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 17721) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OK 17721) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OK 17721) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2024-11-04 |