| NPI | 1851142731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 80404) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CT 78416) |
| Enumeration Date | 2024-03-29 |
| Last Update Date | 2025-08-07 |