| NPI | 1740471929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX P2988) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301091546) |
| 207N00000X Dermatology (Licence: TX P2988) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301091546) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX P2988) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2019-11-25 |