| NPI | 1174508147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX J4566) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX J4566) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX J4566) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2017-08-08 |