| NPI | 1679002729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL MD.44256) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.142138) |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2025-05-19 |