| NPI | 1043578610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA 20A14129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20A14129) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2020-07-20 |