| 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 |