| NPI | 1104182393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 150033) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD457258) |
| 207N00000X Dermatology (Licence: CA 150033) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD457258) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD457258) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA 150033) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-04-02 |
| Last Update Date | 2022-08-07 |