NPI | 1558821678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME175097) |
Additional Taxonomies | 207N00000X Dermatology (Licence: SD 14546) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-03-24 |
Last Update Date | 2025-08-05 |