| NPI | 1255745915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX S1371) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX BP10049140) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2019-12-19 |