| NPI | 1013473800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AK 217300) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: VA 0102206480) | |
| Enumeration Date | 2019-02-16 |
| Last Update Date | 2024-02-15 |