| NPI | 1760665707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7613304-1205) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 7613304-1205) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2024-03-05 |