| NPI | 1851593065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A100261) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A100261) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA A100261) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-09-23 |