| NPI | 1174027882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.144717) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CO DR.0070048) |
| 207N00000X Dermatology (Licence: KY 55530) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2023-06-19 |