| NPI | 1831326941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 373544-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A108313) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 373544-1205) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-12-14 |