| NPI | 1376006742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0102207797) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MB11303400) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2023-06-01 |