NPI | 1346355633 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SC 36744) |
Additional Taxonomies | 207N00000X Dermatology (Licence: SC 36744) |
207N00000X Dermatology (Licence: GA 043123) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 043123) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: GA 043123) | |
Enumeration Date | 2006-08-20 |
Last Update Date | 2022-10-28 |