| NPI | 1528597044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 5101025916) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 11008558-1204) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5101023189) | |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2021-10-07 |