| NPI | 1083843221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 65262) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 65262) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA 65262) | |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2022-07-21 |