| NPI | 1649277658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 46939-20) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 46939) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2024-12-11 |