| NPI | 1073740833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: NE 25822) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301501420) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2023-03-02 |