| NPI | 1235861873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 84904-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ND RL18780) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2026-10-06 |