| NPI | 1124641402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 327724) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10072113) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2025-12-18 |