| NPI | 1225047012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX K0518) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX K0518) |
| 163WW0000X Registered Nurse, Wound Care (Licence: TX k0518) | |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-10-24 |