NPI | 1346816568 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: MA 1023265) |
Additional Taxonomies | 207N00000X Dermatology (Licence: FL 36284) |
390200000X Student in an Organized Health Care Education/Training Program | |
390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 289826) | |
Enumeration Date | 2021-05-28 |
Last Update Date | 2025-07-23 |