| NPI | 1962931766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD482396) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX R9527) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2023-11-27 |