| NPI | 1225442247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A142278) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 260111) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2023-10-25 |