| NPI | 1588007520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 91787531205) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207R00000X Internal Medicine (Licence: ID MRM-1316) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 91787753) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 91787753) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2017-05-09 |