| NPI | 1700997988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME147002) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NV 20282) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME147002) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 20282) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME147002) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2022-04-22 |