| NPI | 1144789405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD.MD.61397788) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MO 2020015245) |
| 207R00000X Internal Medicine (Licence: MT MED-RES-LIC-77253) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2023-06-23 |