| NPI | 1366823841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 295724-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125066625) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2019-09-03 |