| NPI | 1750564407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A116055) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 207N00000X Dermatology (Licence: MN 51287) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA A116055) | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2014-03-10 |