| NPI | 1952806317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT MED-PHYS-LIC-126918) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MT MED-PHYS-LIC-126918) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2023-08-02 |