| NPI | 1497770572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX G0686) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA MD.013075) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2017-02-14 |