| NPI | 1376002675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX U3801) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX U3801) |
| Enumeration Date | 2019-03-16 |
| Last Update Date | 2024-05-23 |