| 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 |