| NPI | 1033466487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P4075) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX P4075) |
| Enumeration Date | 2012-08-03 |
| Last Update Date | 2023-05-15 |