| NPI | 1821482464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL DO.2171) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AL DO.2171) |
| 207N00000X Dermatology (Licence: MI 5101024510) | |
| Enumeration Date | 2015-03-21 |
| Last Update Date | 2022-09-02 |