| NPI | 1871121509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD480251) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT223298) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2024-03-18 |