| NPI | 1700147501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KS 05-41562) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KS 05-41562) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NE 1088) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2023-07-01 |