NPI | 1659833622 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: OH 35.147217) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
207N00000X Dermatology (Licence: IA R-11726) | |
Enumeration Date | 2019-04-01 |
Last Update Date | 2023-05-30 |