NPI | 1063455343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA G074638) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G074638) |
207ND0900X Dermatology, Dermatopathology (Licence: CA G074638) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: CA G074638) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: CA G074638) | |
Enumeration Date | 2006-06-14 |
Last Update Date | 2013-08-30 |