NPI | 1316444565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: GA 92896) |
Additional Taxonomies | 207N00000X Dermatology (Licence: LA 320110) |
Enumeration Date | 2018-04-12 |
Last Update Date | 2022-07-29 |