| NPI | 1215374251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MT 66519) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 192167) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-10-03 |