| NPI | 1942761721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 13012-320) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 13012-320) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-07-25 |