| NPI | 1164876801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A169244) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 125.068785) |
| 207R00000X Internal Medicine (Licence: IL 125.068785) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-19 |
| Last Update Date | 2021-12-20 |