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 |