| NPI | 1215677232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A207667) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX V4743) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-06-05 |