| NPI | 1013612829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MO 2024026005) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: OK 0627R) | |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-11-18 |