| NPI | 1831650548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 306483) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 306483) |
| 207R00000X Internal Medicine (Licence: NY 306483) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2022-01-05 |