| NPI | 1528485448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A159868) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R4021) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2020-03-10 |