| NPI | 1033472915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 51526) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IN 01078453A) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX Q8749) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: KY 51526) | |
| 207N00000X Dermatology (Licence: IN 01078453A) | |
| 207N00000X Dermatology (Licence: TX Q8749) | |
| Enumeration Date | 2012-06-16 |
| Last Update Date | 2023-10-04 |