| NPI | 1588875819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: FL ME0124368) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: OH 57.011035) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 248030) | |
| 207N00000X Dermatology (Licence: NY 248030) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 248030) | |
| 207N00000X Dermatology (Licence: MD D0076460) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: MD D0076460) | |
| 207N00000X Dermatology (Licence: FL ME0124368) | |
| 207N00000X Dermatology (Licence: VA 0101258312) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: VA 0101258312) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2015-12-17 |