| NPI | 1205325388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: TN 68710) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VT 060-0004898) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 292792) | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2023-10-22 |