| NPI | 1679993265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX R5012) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R5012) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX R5012) | |
| 207WX0200X Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery (Licence: TX R5012) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX R5012) | |
| 207X00000X Orthopaedic Surgery (Licence: PA OT015734) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2023-05-12 |