| NPI | 1972863389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301100701) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MI 4301100701) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2026-01-14 |