NPI | 1992201875 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME162846) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME162846) |
Enumeration Date | 2018-04-01 |
Last Update Date | 2025-08-15 |