| NPI | 1912292657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 73450) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: FL ME114104) | |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2022-07-22 |