| NPI | 1780200253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 13869905-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020015723) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 13869905-1205) | |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2024-04-18 |