NPI | 1679054043 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: RI LA00016) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CT 61812) |
Enumeration Date | 2018-08-23 |
Last Update Date | 2020-01-03 |