NPI | 1902845738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 31923) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 31923) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 31923) | |
Enumeration Date | 2006-06-06 |
Last Update Date | 2025-09-11 |