| NPI | 1992948939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 291135) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX 585148) |
| 207N00000X Dermatology (Licence: FL OS11811) | |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2017-12-11 |