| NPI | 1336760677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101285793) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WV 35110) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CT 81146) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 709528) | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2025-06-12 |