| NPI | 1942706650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 34596) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: SD 0406) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2022-08-16 |