NPI | 1124078902 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: AL M.D.25680) |
Additional Taxonomies | 207N00000X Dermatology (Licence: AL 25680) |
207NS0135X Dermatology Procedural Dermatology (Licence: AL MD25680) | |
Enumeration Date | 2006-05-11 |
Last Update Date | 2023-12-05 |