| NPI | 1124689229 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA12173200) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ 25MA12173200) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA MT227495) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-06-28 |
| Last Update Date | 2024-09-12 |