| NPI | 1245421429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N4239) |
| Additional Taxonomies | 207RA0000X Internal Medicine Adolescent Medicine (Licence: TX BP10029412) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2013-01-10 |