| NPI | 1366805517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35139165) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.028833) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NM RS2020-0028) | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2021-04-30 |