NPI | 1356662621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: IA MD-41607) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: IA MD-41607) |
Enumeration Date | 2010-06-21 |
Last Update Date | 2014-04-26 |