| NPI | 1043620065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 63195) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OK C081310159) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: AZ 63195) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-10-06 |