| 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 |