NPI | 1376001479 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2022-02190) |
Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NC 2022-02190) |
Enumeration Date | 2019-03-07 |
Last Update Date | 2024-08-07 |