| NPI | 1053974659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX T9776) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10066733) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP20071166) | |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2023-07-14 |