| NPI | 1750887444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 82274) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 66462) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2025-12-05 |