| NPI | 1215400031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 9488-851) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 17959-40) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 9488-851) | |
| Enumeration Date | 2019-01-03 |
| Last Update Date | 2023-03-27 |