| NPI | 1366964678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX V2174) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 23084) |
| 207Q00000X Family Medicine (Licence: IA R10992) | |
| 207Q00000X Family Medicine (Licence: TX R10992) | |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2025-09-04 |