NPI | 1013988260 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NV MD8425) |
Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NV MD8425) |
Enumeration Date | 2006-01-27 |
Last Update Date | 2024-04-16 |