| NPI | 1356977359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX U3310) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U3310) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2025-12-08 |