| NPI | 1457666562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: UT 9017921) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 9017921) |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: UT 9017921) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: UT 9017921) | |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2019-12-16 |