| NPI | 1073186250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR PG215586) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: MO 2022020793) | |
| Enumeration Date | 2021-07-23 |
| Last Update Date | 2023-07-20 |