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 |