NPI | 1245676774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 51796) |
Additional Taxonomies | 207N00000X Dermatology (Licence: SC 51796) |
207R00000X Internal Medicine (Licence: NC 191622) | |
Enumeration Date | 2013-05-10 |
Last Update Date | 2020-10-13 |