| NPI | 1821475542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 280093) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 263286) |
| 207N00000X Dermatology (Licence: CA A144733) | |
| Enumeration Date | 2015-05-01 |
| Last Update Date | 2020-01-06 |