| NPI | 1336889559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WY 19102A) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2026-06-02 |