NPI | 1871522664 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: CA G0517340) |
Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: CA G0517340) |
207NS0135X Dermatology, Procedural Dermatology (Licence: CA G0517340) | |
Enumeration Date | 2006-07-02 |
Last Update Date | 2007-07-08 |