| NPI | 1003033838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX M6002) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX M6002) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-01-30 |