NPI | 1053421081 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MO 2009003012) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2009003012) |
207NS0135X Dermatology Procedural Dermatology (Licence: MO 2009003012) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2022-08-23 |