| NPI | 1831458363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: LA 306292) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 008212132) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2018-09-19 |