| NPI | 1770880007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX Q3000) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: TX Q3000) |
| 207N00000X Dermatology (Licence: TX Q3000) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: TX Q3000) | |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2019-04-19 |