NPI | 1689136137 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NY 305484) |
Additional Taxonomies | 208D00000X General Practice (Licence: NY 305484) |
Enumeration Date | 2019-04-03 |
Last Update Date | 2024-11-05 |