| NPI | 1780114876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: OH 35145662) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 68092) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 272225) | |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-05-24 |