NPI | 1962453795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: OK 17800) |
Additional Taxonomies | 207N00000X Dermatology (Licence: OK 17800) |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OK 17800) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: OK 17800) | |
Enumeration Date | 2006-05-15 |
Last Update Date | 2021-06-30 |