NPI | 1912907452 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD052489L) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD052489L) |
Enumeration Date | 2005-07-27 |
Last Update Date | 2015-01-20 |