| NPI | 1104898188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M5195) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX M5195) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2023-02-20 |