| NPI | 1043666274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ND 16544) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 67131) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2020-07-13 |