| NPI | 1578901047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX U4774) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX U4774) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2023-08-14 |