| NPI | 1811960503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: RI MD20143) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 239330) |
| Enumeration Date | 2006-02-11 |
| Last Update Date | 2025-12-19 |