NPI | 1386637122 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: MD D0020835) |
Additional Taxonomies | 207N00000X Dermatology (Licence: WV 10481) |
Enumeration Date | 2005-08-26 |
Last Update Date | 2010-07-12 |