NPI | 1689676132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME71519) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME71519) |
207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME71519) | |
207ND0900X Dermatology, Dermatopathology (Licence: FL ME71519) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: FL ME71519) | |
Enumeration Date | 2005-08-15 |
Last Update Date | 2007-07-08 |