| NPI | 1215220454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: GA 73538) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: GA 73538) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 47896) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: KY 47896) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2020-06-12 |