NPI | 1558347526 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 47861) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 37751) |
207N00000X Dermatology (Licence: MN 47861) | |
Enumeration Date | 2005-12-21 |
Last Update Date | 2020-10-05 |