| NPI | 1427579929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101024479) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151010686) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101023631) | |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2021-06-08 |