| NPI | 1831379692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX G1883) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX G1883) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2023-08-25 |