| NPI | 1487074084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX R5338) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP20053749) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2020-08-26 |