| NPI | 1588851125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: AL 37128) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: AL 37128) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 290109) | |
| 363AS0400X Physician Assistant, Surgical (Licence: NY 012082) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2022-05-14 |