| NPI | 1790042620 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX R9509) | 
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R9509) | 
| Enumeration Date | 2012-04-17 | 
| Last Update Date | 2025-08-01 |