NPI | 1003084591 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61392866) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NY 269584-1) |
Enumeration Date | 2008-02-18 |
Last Update Date | 2023-08-31 |