| NPI | 1518175918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 002711) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10025312) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2008-01-16 |