| NPI | 1427257070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX Q5329) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2018-11-15 |