| NPI | 1598086720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 9869105-1204) |
| Additional Taxonomies | 208D00000X General Practice (Licence: OR pg151474) |
| 207N00000X Dermatology (Licence: OR DO155462) | |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2023-02-16 |