| NPI | 1699797811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: UT 52749251205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 5274925-1205) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2017-01-17 |