| NPI | 1366559866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N0736) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60025025) |
| 207R00000X Internal Medicine (Licence: TX N0736) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2012-08-16 |