| NPI | 1942206180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX J4105) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TX 45D0913782) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2017-05-16 |