| NPI | 1073515839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 001096-1) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 0010961) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-09-11 |