| NPI | 1841424272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MA 000000000) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 240818) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2024-05-30 |