| NPI | 1285025478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR DO192668) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL OS14107) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2021-04-12 |