| NPI | 1508252784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101286129) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: NY 299230) | |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2026-03-17 |