| NPI | 1649352964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: PA MD434064) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: SC LL27743) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: CT 047462) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 260244-1) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2017-01-18 |