NPI | 1992084735 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX Q8950) |
Additional Taxonomies | 207N00000X Dermatology (Licence: TX Q8950) |
Enumeration Date | 2011-08-10 |
Last Update Date | 2019-09-13 |