| NPI | 1285033290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 86940) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S4347) |
| 208D00000X General Practice (Licence: VA 0101259271) | |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2026-05-26 |