NPI | 1407433220 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: TX V9729) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: TX V9729) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX V9729) | |
Enumeration Date | 2021-03-26 |
Last Update Date | 2025-09-22 |