NPI | 1376585539 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207N00000X Dermatology (Licence: NY 222859) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 222859-1) |
207NS0135X Dermatology, Procedural Dermatology (Licence: NY 222859) | |
207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 222859) | |
Enumeration Date | 2006-06-12 |
Last Update Date | 2014-01-09 |