| NPI | 1003251943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R2622) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX R2622) |
| 207R00000X Internal Medicine (Licence: TX BP10047202) | |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2022-01-04 |