NPI | 1902953722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: TN 43761) |
Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: TN 43761) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TN 43761) | |
Enumeration Date | 2007-01-04 |
Last Update Date | 2014-04-01 |