| NPI | 1679928832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 009559) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 283325) |
| 207N00000X Dermatology (Licence: AZ 009559) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 009559) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2024-02-21 |