| NPI | 1558347229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ MA61267) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 202786-1) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ MA61267) | |
| 207N00000X Dermatology (Licence: NJ MA61267) | |
| 207N00000X Dermatology (Licence: NY 2027861-1) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: NJ MA61267) | |
| 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: NY 202786-1) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NJ MA61267) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: NY 202786-1) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NJ MA61267) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: NY 202786-1) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2015-10-14 |