| NPI | 1073585907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD441292) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101236929) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA08860400) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2013-05-27 |