| NPI | 1053468934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CA A 109486) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 247778) |
| 207N00000X Dermatology (Licence: CA A 109486) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-10-18 |