| NPI | 1457790180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10279690-1204) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX 577682) |
| Enumeration Date | 2013-06-15 |
| Last Update Date | 2018-07-11 |