NPI | 1104321587 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 91881) |
Additional Taxonomies | 207N00000X Dermatology (Licence: GA 91881) |
Enumeration Date | 2018-03-27 |
Last Update Date | 2024-05-23 |