| NPI | 1023235579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OK 6596) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX P0829) |
| 207N00000X Dermatology (Licence: TX P0829) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-25 |