| NPI | 1609336692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A179216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PTL2239) |
| Enumeration Date | 2019-03-25 |
| Last Update Date | 2024-10-01 |