| NPI | 1669868493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR PG172025) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OR DO177547) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-08-02 |