| NPI | 1720039829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: FL ME95816) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL 95816) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2025-03-25 |