NPI | 1265433072 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G50480) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA G50480) |
207NS0135X Dermatology Procedural Dermatology (Licence: CA G50480) | |
Enumeration Date | 2005-08-02 |
Last Update Date | 2023-08-22 |