NPI | 1114450889 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NE 34491) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NE 34491) |
Enumeration Date | 2017-04-09 |
Last Update Date | 2022-07-18 |