NPI | 1407800501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD054641L) |
Additional Taxonomies | 207N00000X Dermatology (Licence: ID M7012) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: ID M7012) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: ID M7012) | |
Enumeration Date | 2006-05-22 |
Last Update Date | 2020-08-10 |