| NPI | 1063481646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 537110371204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 5371038-1204) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2021-12-07 |