| NPI | 1336671429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD480936) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA11108600) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2023-05-09 |