| NPI | 1023567914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PR 24090) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2022-01667) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2024-12-03 |