| NPI | 1912351032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101268875) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2022-01217) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2022-01217) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: VA 0101268875) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2023-11-21 |