| NPI | 1043674237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD471374) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 972668839) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2024-11-07 |