| NPI | 1588154520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD476472) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA FA1462489) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-05-15 |
| Last Update Date | 2022-06-23 |