| NPI | 1700229283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 291490) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 291490) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-10-09 |