NPI | 1083009351 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-02625) |
Additional Taxonomies | 207N00000X Dermatology (Licence: PA OS019917) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2023-02625) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA OS019917) | |
Enumeration Date | 2015-04-02 |
Last Update Date | 2025-08-18 |