| NPI | 1033640537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A165460) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2022-06-24 |