| NPI | 1659876308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OH 34.017077) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0102207757) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-10-20 |