| NPI | 1700310240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S6991) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2025-05-19 |