| NPI | 1942402169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID O-0559) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 4692) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID O-0559) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: ID O-0559) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2022-11-03 |