| NPI | 1629494935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S5483) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S5483) |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2024-04-26 |