| NPI | 1619176906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD438267) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT189152) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2013-01-10 |