| NPI | 1891369369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A192350) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PR 36236-R) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-05-24 |