NPI | 1720328107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA 132174) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 132174) |
Enumeration Date | 2013-02-22 |
Last Update Date | 2024-02-22 |