| NPI | 1407321722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 7858417-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 7858417-4405) |
| Enumeration Date | 2018-10-13 |
| Last Update Date | 2025-03-19 |