| NPI | 1396065470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX Q6096) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX Q6096) |
| 207N00000X Dermatology (Licence: SC 85301) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 71625) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-02-03 |