| NPI | 1093918658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD179361) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 103786) |
| 207N00000X Dermatology (Licence: WA MD60286336) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: AZ 48763) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2023-06-12 |