NPI | 1417946484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NE 18056) |
Additional Taxonomies | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: NE 18056) |
207NS0135X Dermatology Procedural Dermatology (Licence: NE 18056) | |
207ND0900X Dermatology Dermatopathology (Licence: NE 18056) | |
207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NE 18056) | |
207NP0225X Dermatology Pediatric Dermatology (Licence: NE 18056) | |
Enumeration Date | 2005-10-20 |
Last Update Date | 2014-10-15 |