| NPI | 1982086526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A147523) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 263921) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2020-09-30 |