| NPI | 1629079199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9071) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX K9071) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2021-05-19 |