| NPI | 1477813855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301103068) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: MI 4301103068) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT201711) | |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2018-04-25 |