| NPI | 1033630330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101279110) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101279110) |
| 207N00000X Dermatology (Licence: NY 295178) | |
| 207N00000X Dermatology (Licence: PA MD478832) | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2025-11-19 |