NPI | 1346432440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TX M6490) |
Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX M6490) |
207N00000X Dermatology (Licence: TX M6490) | |
Enumeration Date | 2007-08-13 |
Last Update Date | 2019-10-31 |