NPI | 1255569273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: OR DO157838) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101018458) |
Enumeration Date | 2009-06-29 |
Last Update Date | 2013-05-08 |