NPI | 1477964005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: TX R5778) |
Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology (Licence: TX R5778) |
Enumeration Date | 2014-05-16 |
Last Update Date | 2024-06-27 |