NPI | 1962651679 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD457574) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA A98058) |
207NP0225X Dermatology, Pediatric Dermatology (Licence: PA MD457574) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MA09814900) | |
Enumeration Date | 2008-09-17 |
Last Update Date | 2019-08-22 |