| NPI | 1629494935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: TX S5483) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX S5483) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX S5483) | |
| Enumeration Date | 2014-03-11 |
| Last Update Date | 2025-07-29 |