| NPI | 1760453039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME147442) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX K5512) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME147442) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX K5512) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX K5512) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME147442) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-08-11 |