| NPI | 1508052036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX N9211) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD438676) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2025-09-10 |