NPI | 1093169633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CT 68012) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NY 308350) |
Enumeration Date | 2016-04-20 |
Last Update Date | 2023-01-13 |