NPI | 1912017245 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036-107830) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036-107830) |
207N00000X Dermatology (Licence: IA 02938) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 02938) | |
Enumeration Date | 2006-08-30 |
Last Update Date | 2008-08-15 |