| NPI | 1356977359 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207N00000X Dermatology (Licence: TX U3310) | 
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX U3310) | 
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-21 | 
| Last Update Date | 2025-06-11 |