| NPI | 1083873517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NY 257283) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA A95678485) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: NY 257283) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-06-06 |