| NPI | 1205121324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 282257-1) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT199988) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: MA 262904) | |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2016-11-10 |