| NPI | 1699424846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 1699424846) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 1699424846) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2023-07-27 |