| NPI | 1336536143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S0650) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX s0650) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2021-07-27 |