| NPI | 1861489049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX H6685) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX H6685) |
| 207ND0900X Dermatology Dermatopathology (Licence: TX H6685) | |
| 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: TX H6685) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: TX H6685) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: TX H6685) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2023-03-07 |