| NPI | 1346635406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.135937) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11018967A) |
| Enumeration Date | 2015-04-05 |
| Last Update Date | 2020-10-31 |