| NPI | 1609300649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A178273) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: WA 61263332) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: WA 61263332) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: WA 61263332) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2025-04-07 |