| NPI | 1689052748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL OS15423) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: FL OS15423) | |
| 208D00000X General Practice (Licence: FL OS15423) | |
| Enumeration Date | 2015-05-09 |
| Last Update Date | 2023-11-08 |