| NPI | 1174612162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX H7651) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX H7651) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-11-27 |