| NPI | 1477501005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX F1471) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX F1471) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2016-10-11 |