NPI | 1447888540 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD61654958) |
Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD61654958) |
Enumeration Date | 2020-04-01 |
Last Update Date | 2025-09-24 |