| NPI | 1750769949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD224801) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R8921) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2026-01-25 |