NPI | 1902040777 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD186821) |
Additional Taxonomies | 207N00000X Dermatology (Licence: CA A113764) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2009-04-23 |
Last Update Date | 2018-07-13 |