NPI | 1942583331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: PR 18976) |
Additional Taxonomies | 208D00000X General Practice (Licence: PR 18976) |
Enumeration Date | 2011-09-22 |
Last Update Date | 2024-08-06 |