NPI | 1386681005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 1620908905) |
Additional Taxonomies | 207N00000X Dermatology (Licence: UT 1620901205) |
Enumeration Date | 2006-06-01 |
Last Update Date | 2025-09-11 |