| NPI | 1821441486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301501765) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301501765) |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: MI 4301501765) | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2020-07-16 |