| NPI | 1952760233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA A203532) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A203532) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2025-07-07 |