| NPI | 1639303373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CT 051084) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT194913) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT194913) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2016-03-21 |