| NPI | 1063405025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 182393-1) |
| Additional Taxonomies | 174400000X Specialist |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 182393) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2022-06-15 |