| NPI | 1720615222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO DR.0075463) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0075463) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2026-04-09 |