| NPI | 1720510431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 57163) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 57163) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2026-02-24 |