| NPI | 1124439757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA09959400) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MS 24922) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-16 |
| Last Update Date | 2020-08-28 |