| NPI | 1639490386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 9332631-1204) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: MN 54109) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: UT 9332631-1204) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2021-09-08 |