| NPI | 1861684748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SD 8156) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SD 8156) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: SD 8156) | |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2026-05-15 |