| NPI | 1134356728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VT 042-0017489) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 53518) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 158106) | |
| 207N00000X Dermatology (Licence: MN 105037) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2024-01-17 |