| NPI | 1245550425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: SD 9995) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 264037) |
| 207R00000X Internal Medicine (Licence: TX BP10038253) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2016-08-12 |