| NPI | 1346773496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD474122) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 310149-01) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2022-07-08 |