| NPI | 1720427024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 9393) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 9393) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NV DO3071) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 20A17449) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2026-02-24 |