| NPI | 1922442599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MN 62118) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 49522) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2022-07-21 |