| NPI | 1922257146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX P8407) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: TX P8407) |
| Enumeration Date | 2008-09-11 |
| Last Update Date | 2025-05-27 |