| NPI | 1902981533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M6586) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 20A8958) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX M6586) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2020-10-02 |