| NPI | 1487000154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S4842) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 32318) |
| Enumeration Date | 2016-05-11 |
| Last Update Date | 2025-12-02 |