| NPI | 1093997686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 274988) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: VA 0101245688) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: PA MD451829) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2023-03-07 |