NPI | 1285033290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: TX S4347) |
Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101259271) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2014-08-14 |
Last Update Date | 2022-03-09 |