| NPI | 1124693288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL OS22349) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 5151015061) |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2025-06-30 |