| NPI | 1780115857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A173513) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA A173513) |
| 207R00000X Internal Medicine (Licence: NC 226879) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 226879) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2024-02-27 |