NPI | 1922092071 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MN 52922) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: AZ 52558) |
207NS0135X Dermatology, Procedural Dermatology (Licence: WI 60010) | |
207N00000X Dermatology (Licence: IA 28611) | |
207N00000X Dermatology (Licence: AZ 52558) | |
207N00000X Dermatology (Licence: WI 60010) | |
207N00000X Dermatology (Licence: MN 52922) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IA 28611) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 52558) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WI 60010) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: IA 28611) | |
Enumeration Date | 2005-09-06 |
Last Update Date | 2021-01-28 |