| NPI | 1629397120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 261760) |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2019-06-17 |