NPI | 1962822999 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME125985) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME125985) |
Enumeration Date | 2014-04-17 |
Last Update Date | 2021-12-06 |