| NPI | 1912391897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 20876) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 162860) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 162860) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA 162860) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2024-07-19 |