NPI | 1720085582 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NE 18783) |
Additional Taxonomies | 207N00000X Dermatology (Licence: IA 28654) |
Enumeration Date | 2005-07-07 |
Last Update Date | 2012-04-03 |