NPI | 1609801760 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA g4281) |
Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: CA g4281) |
207ND0900X Dermatology, Dermatopathology (Licence: CA g4281) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: CA g4281) | |
Enumeration Date | 2006-07-11 |
Last Update Date | 2009-08-23 |