| NPI | 1962965798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NE 32864) |
| Additional Taxonomies | 2083A0100X Preventive Medicine Aerospace Medicine (Licence: NE 32864) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2025-02-21 |