| NPI | 1700310240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MD D0106790) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL D0106790) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2026-05-05 |