NPI | 1841269248 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD00041565) |
Additional Taxonomies | 174400000X Specialist (Licence: WA MD00041565) |
Enumeration Date | 2006-03-16 |
Last Update Date | 2024-03-15 |