| NPI | 1114613742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10083891) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP10083891) |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2023-04-22 |