| NPI | 1083009351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA OS019917) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2023-02625) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA OS019917) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2023-02625) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2024-05-01 |