NPI | 1861506230 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174400000X Specialist (Licence: AZ 25383) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 25383) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 25383) | |
Enumeration Date | 2006-08-19 |
Last Update Date | 2024-09-20 |