| NPI | 1295027910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R1001) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX R1001) |
| Enumeration Date | 2011-05-13 |
| Last Update Date | 2025-07-28 |