| NPI | 1902484934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101286218) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101286218) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-03-31 |
| Last Update Date | 2026-08-27 |