| NPI | 1013126390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R5096) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX BP10026779) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: TX BP10026779) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-04-04 |