NPI | 1992902662 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102206282) |
Additional Taxonomies | 171000000X Military Health Care Provider |
Enumeration Date | 2007-06-27 |
Last Update Date | 2024-07-16 |