| NPI | 1770779050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 6099540-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 6099540-1205) |
| 207ND0900X Dermatology, Dermatopathology (Licence: UT 60995401205) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 60995401205) | |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2021-11-05 |