| NPI | 1912992843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AR E1486) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX L1754) |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2024-02-13 |