| NPI | 1588044978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX S0539) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OK 31585) |
| 208D00000X General Practice (Licence: TX S0539) | |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2020-05-14 |