NPI | 1063406965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 28242) |
Additional Taxonomies | 207N00000X Dermatology (Licence: WI 28242) |
Enumeration Date | 2005-09-07 |
Last Update Date | 2020-10-01 |