NPI | 1396065470 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX Q6096) |
Additional Taxonomies | 207N00000X Dermatology (Licence: TX Q6096) |
207N00000X Dermatology (Licence: SC 85301) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 71625) | |
Enumeration Date | 2010-06-10 |
Last Update Date | 2023-02-03 |