| NPI | 1730348673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME118963) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 208D00000X General Practice (Licence: GA 64505) | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2014-06-26 |