NPI | 1881629590 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101237321) |
Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101237321) |
207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101237321) | |
Enumeration Date | 2006-07-11 |
Last Update Date | 2011-01-13 |