| NPI | 1306106547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60726633) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A130849) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD457554) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA MD60726633) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2022-07-21 |