| NPI | 1962764092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 313757) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MA 252998) |
| 207N00000X Dermatology (Licence: MA 226434) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 252998) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2024-05-07 |