| NPI | 1396155297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 280740) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 280740) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2024-05-31 |