| NPI | 1942829882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR DO218911) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR DO218911) |
| 207N00000X Dermatology (Licence: WA OP61536881) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA OP61536881) | |
| Enumeration Date | 2020-04-10 |
| Last Update Date | 2025-09-24 |