NPI | 1861555237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NM A101294) |
Additional Taxonomies | 207N00000X Dermatology (Licence: TX K6817) |
207N00000X Dermatology (Licence: AL D0417) | |
Enumeration Date | 2006-12-18 |
Last Update Date | 2007-07-08 |