| NPI | 1831830959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: MO 2026018729) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IA R-158385) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-08-25 |