| NPI | 1215236112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NI0002X Dermatology Clinical & Laboratory Dermatological Immunology (Licence: LA MD207790) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2015-05-28 |