| NPI | 1548569437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 279719) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 279719) |
| 207N00000X Dermatology (Licence: NJ 25MA09869500) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA09869500) | |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2016-10-14 |