NPI | 1083653653 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD126216) |
Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD00039772) |
Enumeration Date | 2006-06-06 |
Last Update Date | 2020-10-05 |