| NPI | 1245573575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 287056) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 287056) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-04 |
| Last Update Date | 2023-07-07 |