| NPI | 1891798245 |
|---|---|
| Former Name | JOHN RAYMOND RIVERA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 04-26086) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-26086) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KS 04-26086) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-05-18 |