| NPI | 1740654110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2024012056) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2024012056) |
| 207R00000X Internal Medicine (Licence: IL 125074787) | |
| 207N00000X Dermatology (Licence: IL 125074787) | |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2024-07-26 |