NPI | 1194162230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD195653) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2023-00924) |
207N00000X Dermatology (Licence: SC MMD89666MD) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2023-00924) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC MMD89666MD) | |
Enumeration Date | 2013-05-30 |
Last Update Date | 2023-08-29 |