| NPI | 1598269763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: OH 35.148956) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 32697) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-08-01 |