NPI | 1700346509 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS17461) |
Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS17461) |
Enumeration Date | 2019-03-20 |
Last Update Date | 2024-10-16 |