| NPI | 1437300993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PA MD447959) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD447959) |
| 207N00000X Dermatology (Licence: NJ 25MA09384500) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2020-10-02 |