NPI | 1720136823 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA A73051) |
Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: CA A73051) |
207NS0135X Dermatology, Procedural Dermatology (Licence: CA A73051) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A73051) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: CA A73051) | |
Enumeration Date | 2007-01-08 |
Last Update Date | 2015-08-25 |