| NPI | 1932545019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 78796) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: FL UO3752) |
| 208D00000X General Practice (Licence: FL OS12915) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2023-03-31 |