NPI | 1760470496 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102050098) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 50098) |
202K00000X (Licence: VA 0102050098) | |
Enumeration Date | 2005-10-06 |
Last Update Date | 2011-02-02 |