| NPI | 1366896458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101275278) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME151678) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2022-07-23 |