NPI | 1780686352 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: MS 11638) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: MS 11638) |
Enumeration Date | 2005-08-12 |
Last Update Date | 2007-08-31 |