| NPI | 1043772627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD61557697) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 36.161422) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 207N00000X Dermatology (Licence: IL 125.074341) | |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2026-07-28 |