NPI | 1700089851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: NY 151105-1) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA04594500) |
207N00000X Dermatology (Licence: PA MD423153) | |
207N00000X Dermatology (Licence: FL ME103490) | |
Enumeration Date | 2007-06-07 |
Last Update Date | 2010-02-08 |