| NPI | 1720660202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO DR.0069789) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CO 0069789) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CO 0069780) | |
| Enumeration Date | 2021-04-24 |
| Last Update Date | 2024-07-02 |