| NPI | 1861710121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: DC MD042155) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 164835) |
| 207N00000X Dermatology (Licence: MD D0077465) | |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2014-05-22 |