NPI | 1831621721 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: GA 96959) |
Additional Taxonomies | 207N00000X Dermatology (Licence: RI MD17592) |
207N00000X Dermatology (Licence: MI 4301500675) | |
207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: RI MD17592) | |
Enumeration Date | 2017-03-30 |
Last Update Date | 2024-10-08 |