| NPI | 1720073596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 4902) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MT 4902) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT 4902) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2023-02-20 |