| NPI | 1922269448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 62408) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 11014342A) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2017-10-05 |