NPI | 1295791754 |
---|---|
Professional Name | KENNETH A WALLACE |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME73625) |
Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME73625) |
207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME73625) | |
Enumeration Date | 2006-04-25 |
Last Update Date | 2020-04-02 |