| NPI | 1790002855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 259346) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: IN 11015381A) | |
| 207N00000X Dermatology (Licence: NY 243178) | |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2014-08-13 |