NPI | 1851593065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A100261) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A100261) |
207NS0135X Dermatology, Procedural Dermatology (Licence: CA A100261) | |
Enumeration Date | 2007-06-01 |
Last Update Date | 2020-09-23 |