| NPI | 1376172056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL 49130) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: VT 042.0040295) | |
| Enumeration Date | 2020-04-05 |
| Last Update Date | 2026-05-21 |