| NPI | 1407145931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A125941) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: CA A125941) | |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2021-10-13 |