NPI | 1811216807 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: LA MD.205161) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.205161) |
Enumeration Date | 2010-05-31 |
Last Update Date | 2025-10-16 |