| NPI | 1780670448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX K2270) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01043103a) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-02-14 |