| NPI | 1679006522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MO 2019031589) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD209893) |
| 207N00000X Dermatology (Licence: TX S9944) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MO 2019031589) | |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2024-01-24 |