| NPI | 1629604483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: MA 1023149) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 289211) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-12 |
| Last Update Date | 2025-04-14 |