| NPI | 1538583703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301506177) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101258945) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-02-09 |
| Last Update Date | 2022-10-24 |