NPI | 1417070566 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A12033) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A12033) |
207Q00000X Family Medicine (Licence: TX N4544) | |
Enumeration Date | 2007-04-06 |
Last Update Date | 2021-04-12 |