| NPI | 1548647613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2020-00395) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: NC 2020-00395) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2020-08-04 |