NPI | 1720512049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 309233-01) |
Additional Taxonomies | 207N00000X Dermatology (Licence: NY 309233-01) |
207N00000X Dermatology (Licence: NJ 25MA11062100) | |
207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA11062100) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: NY 309233-01) | |
207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA11062100) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2017-04-13 |
Last Update Date | 2022-10-27 |