NPI | 1093776593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: CO 38188) |
Additional Taxonomies | 174400000X Specialist (Licence: CO 38188) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CO 38188) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: CO 38188) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: CO 38188) | |
Enumeration Date | 2006-04-01 |
Last Update Date | 2014-08-01 |