| NPI | 1649664731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 62654) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CT 62654) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2026-02-09 |