| NPI | 1619554110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 14207082-1204) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 14207082-1204) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 14207082-1204) | |
| Enumeration Date | 2021-03-29 |
| Last Update Date | 2025-03-18 |