| NPI | 1225126956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C38690) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX F0346) |
| 207N00000X Dermatology (Licence: WI 77612) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2026-04-05 |