| NPI | 1326201856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 33668) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 69316) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301092081) | |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2017-01-11 |