| NPI | 1124128004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S5517) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME89667) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME89667) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME89667) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-01-10 |