| NPI | 1821524901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA 173979) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 173979) |
| 207N00000X Dermatology (Licence: IL 036.155850) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: CA 173979) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036155850) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2023-07-13 |