NPI | 1053843169 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 42338) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AL 42338) |
207R00000X Internal Medicine (Licence: AZ R76285) | |
207R00000X Internal Medicine (Licence: AZ 56583) | |
Enumeration Date | 2017-03-29 |
Last Update Date | 2023-06-30 |