| NPI | 1699122507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: AR E-14299) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY TP127) |
| 207N00000X Dermatology (Licence: AR E-14299) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2021-11-17 |