| NPI | 1851957054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 59685) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 35.148313) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OH 35.148313) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-09-19 |