| NPI | 1730541707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A167622) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WA MD61016144) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-03-11 |