NPI | 1396230116 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7283004-1206) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: UT 7283004-1206) |
Enumeration Date | 2018-06-25 |
Last Update Date | 2020-09-23 |