| NPI | 1316966575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX n0447) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A84538) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA a84538) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA a84538) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX n0447) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-01-23 |