NPI | 1699761528 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: VT 0420005614) |
Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MA 43419) |
Enumeration Date | 2005-09-26 |
Last Update Date | 2007-07-08 |