| NPI | 1790158012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: TN MD3678) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NC 2016-01634) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 2016-01634) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2024-02-09 |