| NPI | 1699903906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 253130) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 241431) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2014-04-25 |