| NPI | 1033437835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX R2876) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A113333) |
| 207N00000X Dermatology (Licence: TX R2876) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: CA A113333) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TX R2876) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2019-11-19 |