| NPI | 1801843487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX M8524) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 38017) |
| 207Q00000X Family Medicine (Licence: TX M8524) | |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2021-08-18 |