| NPI | 1487397931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL MD.46945) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.252592) |
| Enumeration Date | 2022-04-13 |
| Last Update Date | 2026-04-17 |