| NPI | 1700273349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 297731) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OK 32346) |
| 207R00000X Internal Medicine (Licence: TX BP10052879/591971) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 297731) | |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2021-02-05 |