NPI | 1982601704 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: WI 34598) |
Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: WI 34598) |
Enumeration Date | 2005-07-07 |
Last Update Date | 2024-04-17 |