| NPI | 1629496872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 264816) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD487930C) |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2025-01-07 |