| NPI | 1881190635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 325329) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: UT 12694778-1205) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2023-10-12 |