| NPI | 1518372309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL OS13540) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL UO4176) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2018-09-21 |