| NPI | 1780999805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 00258) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL UO2522) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 00258) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2026-04-17 |