| NPI | 1174918973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 304664) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 304664) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2022-09-08 |