| NPI | 1790216653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AL MD.45116) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: VA 0101271824) | |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2025-05-19 |