| NPI | 1174819049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 34133) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 55234) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 34133) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: AL MD.34133) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2019-02-08 |