NPI | 1225140569 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G72505) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA G72505) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G72505) | |
207ND0900X Dermatology, Dermatopathology (Licence: CA G72505) | |
Enumeration Date | 2006-08-31 |
Last Update Date | 2025-09-11 |