| NPI | 1720217615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IN 01087514A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.140202) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IN 01087514A) | |
| 207R00000X Internal Medicine (Licence: OH 35.140202) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2023-11-09 |