| NPI | 1366400574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 1555) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 50445) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-12-01 |