| NPI | 1366901324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 101335) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 4306) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-10-14 |