NPI | 1639494198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2017030249) |
Additional Taxonomies | 207N00000X Dermatology (Licence: KS 04-37279) |
Enumeration Date | 2010-03-28 |
Last Update Date | 2022-08-18 |