| NPI | 1811956311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WV 23521) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MD D55793) |
| 207Q00000X Family Medicine (Licence: MD D55793) | |
| 207Q00000X Family Medicine (Licence: WV 23521) | |
| 207R00000X Internal Medicine (Licence: MD D0055793) | |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2021-06-22 |