| NPI | 1902225030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301113739) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 71818-20) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301113739) | |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-05-22 |