| NPI | 1720512049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 309233-01) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 309233-01) |
| 207N00000X Dermatology (Licence: NJ 25MA11062100) | |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA11062100) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 309233-01) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: NJ 25MA11062100) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2022-10-27 |