NPI | 1013195759 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME122865) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2015-02351) |
207N00000X Dermatology (Licence: FL ME122865) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2015-02351) | |
Enumeration Date | 2008-02-05 |
Last Update Date | 2025-08-02 |