NPI | 1730348673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME118963) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
208D00000X General Practice (Licence: GA 64505) | |
Enumeration Date | 2008-06-05 |
Last Update Date | 2014-06-26 |