NPI | 1821675117 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 71880) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MN 71880) |
Enumeration Date | 2021-03-24 |
Last Update Date | 2025-06-19 |