| NPI | 1992299622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: AZ 66669) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AZ 66669) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 275251) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX BP10065917) | |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2023-10-20 |