| NPI | 1679815450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: LA 309295) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MS 25836) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2025-07-17 |