| NPI | 1093335820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2023-03374) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 261580) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-06-04 |