| NPI | 1578535910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 216306) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 216306) |
| 207N00000X Dermatology (Licence: CA G073273) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ MA70706) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-10-09 |