| NPI | 1477578607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 225487) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PR 13888) |
| 207N00000X Dermatology (Licence: NY 225487) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 225487) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: PR 13888) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2019-09-05 |