| NPI | 1740505668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 274859) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 274859) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 274859) | |
| Enumeration Date | 2010-04-03 |
| Last Update Date | 2023-11-17 |