| NPI | 1699035626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 297062-01) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA 129827) |
| 207N00000X Dermatology (Licence: MA 270858) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2022-06-15 |