NPI | 1861498065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MA 52251) |
Additional Taxonomies | 207N00000X Dermatology (Licence: MA ma52251) |
Enumeration Date | 2005-06-22 |
Last Update Date | 2010-10-19 |