| NPI | 1679921381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.153199) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 268614) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 57.245012) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2020-06-19 |