| NPI | 1801838537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M5383) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: LA MD.026045) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2016-11-17 |