| NPI | 1396247367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 61271735) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101268327) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2023-10-30 |