NPI | 1023646064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: GA 104339) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 104339) |
Enumeration Date | 2020-03-27 |
Last Update Date | 2025-05-08 |