| NPI | 1326545328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0070029) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX 024277) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX T5316) | |
| Enumeration Date | 2018-04-07 |
| Last Update Date | 2023-07-20 |