| NPI | 1174943690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WY 12943A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP10050057) |
| 207N00000X Dermatology (Licence: MA 274175) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2020-10-15 |