| NPI | 1285951251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NY 261822) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 261822) |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2021-07-23 |