| NPI | 1922700731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA PTL12637) |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2024-07-01 |