| NPI | 1508076928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 3477061205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 3477061205) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 3477061205) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-11-10 |