| NPI | 1912385931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX BP20055598) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10052636) |
| Enumeration Date | 2015-05-11 |
| Last Update Date | 2016-06-13 |