NPI | 1083877393 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA C154031) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MA 253116) |
207N00000X Dermatology (Licence: MO 2009010233) | |
207R00000X Internal Medicine (Licence: IL 125055212) | |
Enumeration Date | 2008-07-07 |
Last Update Date | 2018-07-12 |