| NPI | 1528527561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 68724) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 68724) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2023-10-20 |