| NPI | 1497071716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 04-38390) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL ME119877) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-04-12 |
| Last Update Date | 2015-11-04 |