| NPI | 1831105394 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 18609) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD16342) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT MED-PHYS-LIC-18609) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2025-02-13 |