NPI | 1164472890 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G42285) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA G42285) |
Enumeration Date | 2006-05-11 |
Last Update Date | 2020-10-12 |