| NPI | 1609300649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 61263332) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: WA 61263332) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: WA 61263332) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2022-04-26 |