| NPI | 1871988147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A161745) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MD A526481014547) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2020-07-30 |