| NPI | 1538289012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036128095) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036128095) |
| 207N00000X Dermatology (Licence: MN 49894) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2022-10-24 |