| NPI | 1245596451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: TX P8568) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P8568) |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2023-10-06 |