| NPI | 1770587735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME70658) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME70658) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME70658) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME70658) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2024-12-23 |