| NPI | 1154785152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NC 2021-01225) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2021-01225) |
| 207R00000X Internal Medicine (Licence: NC 218051) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2024-12-12 |