| NPI | 1548792807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101282757) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MA11539300) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA11539300) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: PA MT224939) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA11539300) | |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2024-08-23 |