| NPI | 1043847684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 330888) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 330888) |
| 207R00000X Internal Medicine (Licence: LA 324121) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2023-08-10 |