| NPI | 1649768599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01082544A) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: IN 01082544A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2024-03-18 |