| NPI | 1316141310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: SD 9025) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: MN 103869) |
| 207N00000X Dermatology (Licence: MI 4301089830) | |
| 207N00000X Dermatology (Licence: SD 9025) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301089830) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2023-02-28 |