| NPI | 1063830016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD479758) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MI 4301105082) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD479758) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2022-12-19 |