| NPI | 1821799362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IA R-13522) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: WI 100990) | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2025-08-12 |