| NPI | 1891152641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 75498-20) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 65601) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-01-25 |
| Last Update Date | 2024-05-02 |