| NPI | 1902979909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX N5113) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX N5113) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2022-01-25 |