| NPI | 1053499301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N3492) |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX N3492) |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX N3492) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-05-17 |