NPI | 1669737011 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: TX R2302) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MA 251397) |
207N00000X Dermatology (Licence: PA MT204136) | |
Enumeration Date | 2012-07-11 |
Last Update Date | 2017-05-22 |