| NPI | 1497915730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD451783) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN122223) |
| 207N00000X Dermatology (Licence: FL ME110688) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL ME110688) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME110688) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2014-05-15 |