NPI | 1679651590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA A95507) |
Additional Taxonomies | 174400000X Specialist (Licence: CA A95507) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A95507) | |
Enumeration Date | 2006-11-01 |
Last Update Date | 2019-11-19 |