NPI | 1205006897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: ND 15286) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NY 170293) |
207N00000X Dermatology (Licence: WI 55291-20) | |
207N00000X Dermatology (Licence: CO DR.0058256) | |
Enumeration Date | 2008-03-10 |
Last Update Date | 2020-07-14 |