NPI | 1659344513 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A9328) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA 20A9328) |
Enumeration Date | 2006-02-10 |
Last Update Date | 2024-10-07 |