| NPI | 1952862468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA PTL1315) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 34.016538) |
| 207N00000X Dermatology (Licence: MI 5101027433) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2023-06-28 |