| NPI | 1891143277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 73704) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 68967) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 68967) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: TN 68967) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TN 68967) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2025-07-17 |