| NPI | 1598181828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NV 21353) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: AZ 64641) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 64641) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV 21353) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2023-02-24 |