| NPI | 1801259023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CO 64025) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 64503) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2020-05-29 |