NPI | 1457344640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS004202L) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA OS004202L) |
207NS0135X Dermatology, Procedural Dermatology (Licence: PA OS004202L) | |
Enumeration Date | 2005-08-24 |
Last Update Date | 2022-05-27 |