| NPI | 1508027616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OR MD157327) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX BP10032351) |
| 207N00000X Dermatology (Licence: OR MD157327) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-20 |
| Last Update Date | 2022-02-15 |