| NPI | 1255300976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 057542) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 057542) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 043149) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX L9339) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 057542) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2023-03-31 |