| NPI | 1922688936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101289185) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101289185) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2026-07-18 |