NPI | 1548302243 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA G57525) |
Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G57525) |
207ND0900X Dermatology Dermatopathology (Licence: CA G57525) | |
207NS0135X Dermatology Procedural Dermatology (Licence: CA G57525) | |
Enumeration Date | 2007-02-12 |
Last Update Date | 2007-07-09 |