| NPI | 1265843460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 310434) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A137943) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-05-11 |
| Last Update Date | 2021-09-03 |