| NPI | 1699332635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: RI MD20591) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD20591) |
| 207N00000X Dermatology (Licence: FL ME167826) | |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2025-07-17 |