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 |