| NPI | 1366736407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 248512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 248512) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 248512) | |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2021-06-05 |