| NPI | 1831727718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2023049376) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2023049376) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-05-26 |