NPI | 1861489049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX H6685) |
Additional Taxonomies | 207N00000X Dermatology (Licence: TX H6685) |
207ND0900X Dermatology, Dermatopathology (Licence: TX H6685) | |
207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: TX H6685) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: TX H6685) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: TX H6685) | |
Enumeration Date | 2005-10-03 |
Last Update Date | 2023-03-07 |