| NPI | 1124361233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 10738970-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OR MD182703) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2022-06-23 |