| NPI | 1609263797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD468023) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ND0900X Dermatology Dermatopathology (Licence: PA MD468023) | |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2019-07-03 |