| NPI | 1497725790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX L8995) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX L8895) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX L8895) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2007-08-13 |