| NPI | 1245299379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA C166658) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX H1013) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2020-01-08 |