| NPI | 1861506230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: AZ 25383) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 25383) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AZ 25383) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2024-09-20 |