NPI | 1992774681 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA G80445) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA G80445) |
Enumeration Date | 2006-03-15 |
Last Update Date | 2018-03-17 |