| NPI | 1184251381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T3167) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX T3167) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-06-09 |