| NPI | 1134486582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX Q6500) |
| Additional Taxonomies | 207NP0225X Dermatology, Pediatric Dermatology (Licence: TX Q6500) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2022-07-18 |