| NPI | 1497374623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301518314) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TN 71242) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2026-07-10 |